AccountId: 011433970860
ContactId: 5e200b3c-7061-46f7-a3bb-bc2d7cc8145d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500100 ms
Total Talk Time (AGENT): 196938 ms
Total Talk Time (CUSTOMER): 195249 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/5e200b3c-7061-46f7-a3bb-bc2d7cc8145d_20250410T19:44_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from UC Health. Um, I have briefly just called regarding a claim of mine and I was not given the correct information.
[AGENT][NEUTRAL] Oh OK alright Miss [PII] I can help you with your claim uh is the claim for yourself or are you with a facility uh that's calling on a patient?
[CUSTOMER][NEUTRAL] I'm with the provider, yeah, I'm with the provider.
[AGENT][NEUTRAL] OK. All right. Thank you, Ms. [PII]. What is uh your callback number, ma'am, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, excuse me, policy number is 021.
[CUSTOMER][NEUTRAL] 50702
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then, what is [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then can I please get the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yeah, the the service is $122 2025 dollars for $2,206.
[AGENT][NEUTRAL] OK, let me look up his policy.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] So we did a total bill of $2,206.
[AGENT][NEUTRAL] OK. All right, so I'm gonna put you on a quick hold while I look this claim up for us, Ms. [PII] and I will be right back with you, OK?
[CUSTOMER][NEUTRAL] OK, no worries, yeah, I just want to find the claim for the primary surgeon. They gave me the assistant surgery which has a modifier of AS on there for that same amount for the same data service. I don't want the assistant. I'm calling on behalf of the actual primary doctor.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right. And what's the primary doctor's name in case it's on the claim?
[CUSTOMER][NEUTRAL] Um, I have [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] OK. All right, I'm gonna put you on a.
[CUSTOMER][NEUTRAL] Yeah, I don't want the assistant. I just want the actual like primary doctor.
[AGENT][NEUTRAL] OK, alright. I will look and see what we have on file and I will be right back with you, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Go on.
[AGENT][NEUTRAL] OK, Ms. [PII].
[AGENT][NEUTRAL] What was the claim number that was given to you previously?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim number was 356-562-9.
[AGENT][NEUTRAL] OK, they must have just done it by facility because I'm looking at the data service of [PII] and I do not see a claim on file for the amount that you have given me.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yep, yeah, they gave me all this info that was received [PII] processed on [PII] for 15457. They issued $100 towards the patient responsibility.
[CUSTOMER][NEUTRAL] Give me a check number.
[AGENT][NEUTRAL] Yes, that's correct and and that was for um let me look up the claim itself.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Yeah, if it has a modifier AS on there, that's not what what I'm calling on behalf of. I want the actual provider claim which you guys shouldn't have paid the assistant charge unless you paid the pro like the primary provider.
[AGENT][NEUTRAL] OK, so what we have is just UC Health Corp.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me give you the procedure codes that were paid. There were 2.
[AGENT][NEUTRAL] And the total amount paid as you said was 154.57 and the procedure codes that were paid were 49616.
[AGENT][NEUTRAL] And procedure code 49623.
[CUSTOMER][NEUTRAL] Yeah, but they shouldn't have any modifiers on there. Do they have modifiers on there?
[AGENT][NEGATIVE] I do not see any modifiers.
[CUSTOMER][NEUTRAL] So that's a claim I'm trying to figure out.
[CUSTOMER][NEUTRAL] They gave me information on the claim for the assistance provider.
[CUSTOMER][NEUTRAL] Which was the assistant surgeon.
[AGENT][NEUTRAL] OK. Oh.
[CUSTOMER][NEUTRAL] Which is a modifier AS.
[AGENT][NEUTRAL] Right, so what I'm looking at is.
[AGENT][NEUTRAL] Is a remark that's on the claim that part of the payable benefits were applied to the policy deductible of $100.
[CUSTOMER][NEUTRAL] Yeah, that was for the assistant surgeon. I already got that. We already have that EOB.
[AGENT][NEUTRAL] OK, so looking.
[CUSTOMER][NEUTRAL] I'm trying to figure out for the primary surgeon.
[AGENT][NEUTRAL] Right, so looking at this data service, this claim number 356-562-9 is the only claim on file for that data service.
[CUSTOMER][NEUTRAL] OK, interesting.
[AGENT][NEUTRAL] So you may need to resubmit the claim, yeah, you may need to resubmit.
[CUSTOMER][NEGATIVE] Yeah, cause you guys shouldn't have even paid the assistant before you paid the primary surgeon.
[AGENT][NEUTRAL] Well, our policies are paid um based on deductible, co-pay and co-insurance, um.
[CUSTOMER][NEUTRAL] So that's why. OK.
[CUSTOMER][NEUTRAL] Yeah, I'm aware of that. I'm just saying that you guys shouldn't have paid the assistant before you pay the primary surgeon, which was actually doing the surgery.
[AGENT][NEUTRAL] Right, I understand, yeah, if you can.
[CUSTOMER][NEUTRAL] You guys, yeah, you guys just had that other claim. So I just wanna confirm I have a claims address of [PII].
[AGENT][NEUTRAL] Yes, that is correct and we also have a payer ID number if you wanted to send it electronically.
[CUSTOMER][NEUTRAL] Um, I have to see if we guys actually handle your guys' payer electronically. Sometimes we don't handle all payers like that, but what was the payer ID just so once I get that pulled up after we talk I can check that out.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. Yes, it's 60801.
[AGENT][NEUTRAL] And then we also have a fax number you can send claims in on too.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, and what was the fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. And can I have a call? Are you your call reference number, um, what was your name again? I'm sorry.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Thank you. And then I know you guys do your name and date of birth or data service. I'm so sorry, or today's date, oh my [PII].
[AGENT][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] OK cool I'll go ahead and resubmit that claim because it looks like you guys just don't have that specific claim on file um thank you so much and have a good day.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is that all I can help you with before we go?
[CUSTOMER][NEUTRAL] Yep, that was it.
[AGENT][POSITIVE] OK, well, you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Like